Association between perceived life chaos and medication adherence in a postmyocardial infarction population.
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2013-11
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Abstract
Background
The benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence.Methods and results
Using baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96-2.76), female sex (β=1.22; 95% CI [0.22-2.24]), minority race (β=1.72; 95% CI [0.78-2.66]), having less than high school education (β=2.05; 95% CI [0.71-3.39]), low health literacy (β=2.06; 95% CI [0.86-3.26]), and inadequate financial status (β=1.93; 95% CI [0.87-3.00]). Being married (β=-2.09, 95% CI [-3.03 to -1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02-1.12]) in odds of reporting medication nonadherence.Conclusions
Our results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence.Clinical trial registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277.Type
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Publication Info
Zullig, Leah L, Ryan J Shaw, Matthew J Crowley, Jennifer Lindquist, Steven C Grambow, Eric Peterson, Bimal R Shah, Hayden B Bosworth, et al. (2013). Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circulation. Cardiovascular quality and outcomes, 6(6). pp. 619–625. 10.1161/circoutcomes.113.000435 Retrieved from https://hdl.handle.net/10161/30029.
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Scholars@Duke
Leah L Zullig
Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig leads INTERACT, the Implementation Science Research Collaborative, and is co-leader of Duke Cancer Institute's cancer prevention and control program.
Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 200 peer-reviewed publications.
Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.
Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research
Ryan Shaw
Ryan Shaw serves as the Chief Nurse Innovation Officer for Duke University Health System. By leveraging technology and evidence-based practices, he identifies opportunities to empower nurses to thrive as changemakers, addressing healthcare delivery challenges, improving patient outcomes, and enhancing efficiency.
In his faculty role at the Duke University School of Nursing, he leads research teams focused on digital transformation in healthcare, while also mentoring students to become the next generation of health scientists and clinicians.
Matthew Janik Crowley
Diabetes, Hypertension, Health Services Research
Steven C. Grambow
Transforming research education through innovation, mentorship, and collaboration.
Steven C. Grambow, PhD is Associate Professor and Associate Chair of Education in the Department of Biostatistics and Bioinformatics at Duke University School of Medicine. He serves as Director of the Clinical Research Training Program (CRTP), Duke’s flagship degree-granting program for clinical and translational research education, and as Co-Director of the Workforce Development Pillar of the Duke Clinical and Translational Science Institute (CTSI). Dr. Grambow provides strategic oversight for multiple educational and workforce development initiatives that span the full continuum of learners, from students to faculty.
With over two decades of experience in graduate and professional education, Dr. Grambow has taught statistical methods and research design to more than 1,000 physician-scientists, clinical fellows, and faculty at Duke and the NIH. He has led the CRTP’s core statistics course for over 21 years and has directed or co-directed national and international certificate programs across multiple institutions. His expertise spans classroom, hybrid, and online environments, and he has served as a leader in designing programs that respond to evolving workforce and research needs.
A central focus of Dr. Grambow’s work is building pathways into clinical and translational research careers. He has cultivated longstanding partnerships with academic and community institutions, including North Carolina Central University and Durham Technical Community College, to create educational models that prepare learners for impactful roles in research. His efforts emphasize strong mentorship, practical experience, and tailored program design to meet learners where they are and help them advance.
Dr. Grambow is also at the forefront of educational innovation, leading initiatives that explore the integration of artificial intelligence into biostatistical training and academic workflows. His current work includes faculty development in AI literacy, emerging pedagogical models that support active learning and reflective practice, and new frameworks for clinical research education that emphasize adaptability and cross-disciplinary collaboration.
As a collaborative statistical scientist, Dr. Grambow has contributed to a wide range of clinical research studies, including observational studies, randomized trials, and epidemiologic investigations. His research collaborations have addressed public health and clinical challenges such as amyotrophic lateral sclerosis (ALS), post-traumatic stress disorder (PTSD), Prader-Willi syndrome (PWS), prostate cancer, cardiovascular risk reduction, and substance use recovery.
Dr. Grambow’s leadership has been recognized through institutional and national awards, including teaching honors from the American Statistical Association and Duke University. He brings a unique combination of academic rigor, educational strategy, and programmatic leadership to his roles, helping to shape the future of clinical research training through thoughtful innovation and sustained collaboration.
Bimal Ramesh Shah
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
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